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Member notices

Medical policies

The Regence® Medical Policy Manual contains medical policies approved by Regence. Medical policies are based upon scientific evidence of merit for a particular medical technology. Technology determinations are made using criteria developed by the BlueCross BlueShield Association's® Technology Evaluation.

Oregon state continuation coverage notice

What is continuation coverage?

Oregon law requires that eligible enrolled employees and/or dependents be allowed to continue their existing group health insurance coverage for up to nine months. Continued coverage may or may not include additional coverage such as dental or vision (check with your employer). However, you are responsible for the full cost of any coverage you continue.

Who is eligible?

You are eligible if you are an employee who has had continuous health coverage under one or more employer group plans for at least three months prior to the date your most recent coverage ended. Your spouse and/or children are also eligible to maintain coverage with or without you.

How do I get Oregon state continuation coverage?

You will need to notify Regence BlueCross BlueShield of Oregon that you want to continue your coverage by notifying your employer in writing or calling the Customer Service number on the back of your member ID card.

Your request for continuation coverage must be provided (a) sixty days after the event that triggered your loss of eligibility for coverage or (b) ten days after the date of this notice, whichever is later.

You are responsible for paying your full premium by when it is due. Please contact your employer for more information.

You will need to submit any necessary continuation forms and premiums to your employer within the time periods stated above to continue your current group health insurance plan coverage.

IF YOU FAIL TO DO AS INDICATED ABOVE, YOU MAY LOSE YOUR ABILITY TO CONTINUE YOUR CURRENT GROUP HEALTH INSURANCE COVERAGE.

How do I get more information?

Contact your employer.

Contact our Customer Service representatives at the telephone number on the back of your member ID card.

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Verify benefit coverage

We strongly encourage members to ask their provider to check Regence's website or call us to verify benefit coverage before services are provided. Members may also call Regence for any questions about whether a service is a covered benefit.

Health Care Quality Concerns form

Complete and submit this online form. Your concerns and comments are important to us. If you have concerns about a clinic, doctor or other health care professional, we'd like to hear from you.

Appeal and grievance process

What is an appeal?

An appeal is a written or oral request from a member or, if authorized by the member, the member's representative, to change a previous decision made by Regence BlueCross BlueShield of Oregon concerning:

Access to health care benefits, including an adverse determination made pursuant to utilization review

Claims payment, handling or reimbursement for health care services

Matters pertaining to the contractual relationship between a member and the plan

Other matters as specifically required by state law or regulation

Who is a member?

"Member" is the enrolled employee or contract holder or his/her enrolled dependent.

Who is a member representative?

"Member representative" is any authorized representative of the member.

Member appeals process

When members have concerns about the processing of a claim or other action by Regence BlueCross BlueShield of Oregon and wish to have it reviewed, they or their representative may appeal within 180 days of receiving our written determination—such as an explanation of benefits or a letter denying a pre-authorization request. Appeals may be made either verbally or in writing.

All appeals are reviewed by appropriate Regence BlueCross BlueShield of Oregon staff who were not involved in previous determination(s) and are responded to in writing. For members who need a faster process and whose appeal qualifies, there is an expedited appeal process. Following the internal process, an independent, external review may be available for certain matters. The appeal process varies by type of plan in order to comply with state and federal law. Details are available in the member's benefit book.

If you have any questions, please contact our Customer Service department toll-free at 1 (800) 365-3155. If you want additional information regarding privacy at Regence BlueCross BlueShield of Oregon, refer to our Notice of privacy practices.

Download a printable copy of our appeal process notice (PDF) that includes government resources to turn to if you are not satisfied with our assistance, or if you have additional questions about this notice or your appeal rights.

Pre- and post-sale disclosures for Clark County

You can review these disclosures for Regence BlueCross BlueShield of Oregon members living in Clark County, Wash.

Explanation of agent and broker commissions

The Regence Group and affiliate companies offer benefit plans and services through independent life and health insurance producers and/or brokers. Producers and/or brokers are independent contractors—they are not employees of Regence. Producers and/or brokers must be licensed in the state(s) in which they do business. As a health carrier, we pay producers and brokers commissions for selling our plans and services.

Independent health insurance producers with whom we do business enter into a contract with us, agreeing to fairly represent our plans and services, abide by our privacy policy and requirements, and adhere to our expectations of performance and professionalism in dealing with members who chose us as their health carrier. An independent life and health insurance producer who is paid a commission by the insurance carrier is representing the carrier and the products and services that carrier offers. Most independent health insurance producers represent a variety of insurance companies, which allows them to provide their clients with comparison information to aid in benefit purchase decisions. Most producers and/or brokers are also an excellent resource for questions regarding coverage, and may act as an advocate for their client when questions arise.

It's important to us that you understand the role that your producer or broker plays in the health care and the health benefits industry. In Oregon and Southwest Washington, where we offer our plans and services, independent life and health insurance producers, agencies and brokers perform important services for you as their client. While they are not employees of our company, they are an important part of our sales and service team.

Producers, agencies and brokers with whom we do business are paid commissions for selling and renewing the plans we offer. Our producer commission is part of administrative expenses, which factor into the premium rates we charge for individual policyholders, small group policyholders, and most large employer group policyholders. Large employers and their producers or brokers may negotiate direct compensation fees, in lieu of commissions. You are not required to include an "agent of record" on coverage you purchase with us. We charge the same premium rates for members who elect not to use an producer as we charge for those who do.

In addition to commissions, producers and/or brokers may receive bonuses, administrative service fees or other compensation from us. The compensation we pay may include noncash compensation, such as incentives based on the amount of business they place with us, the products they sell, their overall volume of clients that they maintain with our company, and/or the services they provide to our insured members. Like all costs included in our administrative expenses, the cost of these incentives may have a direct or indirect impact on premium rates.